Purpose: Our purpose was to study the 10-year results of a proximal soft-tissue procedure combined with a Lateral Patellar Facetectomy technique for an isolated osteoarthritis of patellofemoral joint.

Methods: The study group included 39 knees (30 patients). There were 19 female and 11 male patients. Mean age 52 years old (range 40–65). All patients were evaluated at a mean follow-up of 10 years. The indications for surgery were instability of patellofemoral joint with isolated arthritis. Patient outcome scores, patient demographics, and data from a physical examination, x-Ray and TC were collected before and after surgery. A release of the lateral patellofemoral ligament and a retinacular release were performed, leaving the synovial tissue intact to isolate the joint. The lower fibers of the vastus lateralis were released as well, and the release was carried down to the level of the tubercle. Medially, an imbrication of the medial retinacular tissue from the medial aspect of the quadriceps tendon to the proximal aspect of the tibial tubercle, as Insall described, was performed.

Results: At final follow-up, the results were excellent or good in 89% of the knees, fair in 7%, and poor in 3%. Subjective improvement was reported by 90% of patients. Follow-up radiographs showed slow progression of osteoarthritis in the patellofemoral and tibiofemoral compartments, but radiographic appearance did not always correlate with clinical symptoms. The success of this procedure depends largely on relief of pain.

Conclusions: proximal soft-tissue realignment combined with a Lateral Patellar Facetectomy for a severe isolated osteoarthritis of patellofemoral joint is a powerful way to correct malalignment and offload the lateral and distal parts of the patella. This technique relief pain and improved the activity level. Is an effective surgical treatment for middle-aged to elderly active patients with isolated lateral patellofemoral osteoarthritis who want to maintain activity level.

Introduction: Fusion of the knee joint should be the last option for salvage of infected total knee arthroplasty (TKA). Although knee arthrodesis implies lost of function, it is a successful treatment in eradicating the infection and in decreasing pain.

External fixation compression devices have been an excellent method for gaining fusion but, there is no documentation about its ability for obtaining adequate limb alignment with a stable fusion of the knee joint.

Material and Methods: We have retrospectively reviewed the results of knee arthrodesis after infection of TKA using an anteriorly placed unilateral external fixator. In addition, we have assessed patient self-satisfaction.

Postoperative radiographs have been evaluated to digitally measure loss of femoral and tibial bone stock using Engh radiological classification. Moreover, we have quantified tibiofemoral alignment and the section of bony fusion. Fusion of the knee joint was assessed with CT. Patients were interviewed and pain was graded using a Visual Analog Scale (VAS) and self-satisfaction as well as current health status using the 12-item social function survey form (SF12).

Results: From 1992 to 2003, 52 arthrodeses were done for treatment of infected TKA. The average age was 71 years (range, 37–83 years). Type III bone defect according with Engh classification, in femur and/or in tibia, was present in 50% of the patients. The average postoperative tibiofemoral alignment was 1.2° (SD 3.79). The mean time to fusion was 11.26 months (range, 3–30 months). Time to fusion was statistical related with severe bone loss and with the tibiofemoral contact section. The average score according VAS was 1.6 (SD 2.60).

Conclusions: Knee arthrodesis using a monolateral external fixator for infected TKA is an effective method to control infection as well as to obtain knee fusion and pain relief. Severe bone loss, frequently present in infected TKA, was found to be the most relevant factor in achieving tibiofemoral union. The individual clinical result according to SF12 shows a lower quality of life both for physical and mental components compare with general population.

Introduction: From 1972–2003, 205 arthroplasties of infected hips were performed in the Musculoskeletal Infectious Disease Unit of our hospital. Using as a basis the outcome for conventional one-and two-stage hip replacement with cemented implants and antibiotics performed in these patients, we designed a new two-stage hip replacement protocol using «personalized» solid spacers and non-cemented components.

Material and Methods: A total of 44 patients were treated with our protocol. Patient characteristics are described, as well as an elevated incidence of associated disease, the causative microorganisms, and therapy provided. Most of the cases had failed other treatment methods. Strict application of the protocol implied:

Previous identification of the infective microorganism

Results: Reactivation of infection occurred in only one case. The patient was cured with antibiotic administration. The remaining patients remained free of infection for a mean follow up period of 64.54 months (19.77–86.63 months). The septic process was erradicated in 96% of cases. Five-year implant survival was 100%.

Conclusions:

Cement with antibiotics is not essential for prosthesis reimplantation when replacement is performed in two-stage.

Introduction and Objectives: Arthrodesis of the knee is the method that most readily controls septic processes and results in a non-painful, stable knee joint. However, the disadvantages of this technique are shortening of the limb and a loss of joint function.

Materials and Methods: We present here our unit’s experience in the use of the Orthofíx ® transport system on the anterior surface to stabilise this type of arthrodesis. We used radiological techniques to evaluate the alignment and coaptation of the surfaces to be arthodesed. We also assessed functional capacity, postoperative patient satisfaction, rate of repeat arthrodesis, consolidation time, and complications associated with this method.

Results: According to our results, femorotibial arthrodesis with the bone transport system provides all the advantages of monolateral external fixation while allowing compression of the point of arthrodesis, achieving perfect coaptation, and providing extraordinary rigidity to the mounting.

Discussion and Conclusions: As with all other procedures, femorotibial arthrodesis has its complications. The complication directly related to knee arthrodesis is femorotibial non-union, which is correlated with a loss of bone stock, incomplete coaptation, poor alignment of the limb, persistent infection, and inadequate immobilisation. We believe this procedure produces a functional limb with significant relief of pain in most patients.